Factors influencing postoperative delirium in patients with congenital heart disease: A systematic review and meta-analysis.

PROBLEM: Postoperative delirium (POD) is multifactorial and seriously affects prognosis and long-term quality of life in children with congenital heart disease (CHD). In this review, we synthesized evidence on influencing factors for POD in CHD to guide clinical identification and intervention.

METHODS

We conducted a systematic search of nine databases to identify studies on POD risk factors in CHD. To conduct the meta-analysis, we used fixed-effects and inverse-variance heterogeneity models in STATS 18.0.

RESULTS

This meta-analysis included 12 papers comprising 3169 participants. Narrative synthesis suggested that surgical complexity, pain, benzodiazepines, opioids, and aortic cross-clamp time were potential factors influencing POD in CHD. Meta-analysis results showed that age was a protective factor (weighted mean difference [WMD] = -0.03, 95% confidence interval [CI]: -0.05, -0.00). Age younger than 2 years (odds ratio [OR] = 2.18, 95% CI: 1.93, 2.46), longer duration of mechanical ventilation (WMD = 0.70, 95% CI: 0.19, 1.22), developmental delay (WMD = 0.46, 95% CI: 0.21, 0.70), and cyanotic CHD (WMD = 0.68, 95% CI: 0.25, 0.99) were higher risk factors for POD in CHD.

CONCLUSION

This study identified 9 critical influencing factors by reviewing current original studies. Meta-analysis of the existing evidence revealed that young age, especially an age under 2 years, mechanical ventilation, developmental delay, and cyanotic CHD were factors influencing POD in children with CHD.

IMPLICATIONS: This study provides important basis for future nursing staff to identify high-risk children with delirium as early as possible and implement stratified non pharmacological management.